Application for Renewal of
AFA Authorisation
To apply for a renewal of your AFA authorisation under the Financial Advisers Act 2008, please:
1. complete this application form and save it locally for your own future reference
2. arrange payment of the renewal application fee
3. print the completed form, sign it, scan it and email it to [email protected]
4. attach any associated documents to the email.
Please read the AFA Authorisation Renewal Guide and AFA Authorisation Guide which
is available on the FMA website for more information on AFA renewals.
I apply to the Financial Markets Authority (FMA) for renewal
of my AFA authorisation
First name:
Middle name:
Last name:
FSP number:
FAS scope I am currently
authorised to provide:
Date of authorisation:
dd/mm/yyyy
Expiry of authorisation:
dd/mm/yyyy
Preferred daytime contact
phone number:
Application for Renewal of AFA Authorisation | Page 1
Please select TRUE or FALSE for each statement. If you select FALSE for any statement, you must provide
full details of the circumstances in the space provided.
Registration and Authorisation
1
I remain registered on the Financial Service Providers Register.
TRUE
FALSE
Details:
2
I am not a disqualified person under section 14 of the Financial Service Providers
(Registration and Dispute Resolution) Act 2008.
TRUE
I am not debarred from applying for the renewal of my authorisation as an
Authorised Financial Adviser.
TRUE
FALSE
Details:
3
FALSE
Details:
Criminal Convictions
4
not been convicted by a court in New
or overseas of an offence
punishable by imprisonment for a
of six (6) months or more.
TRUE
Details:
Good Character
Please read the AFA Authorisation Guide and in particular section 4 'Proof of Good Character' before
completing the following statements. You must complete the declaration for each statement below in
relation to both New Zealand and overseas jurisdictions.
5a
I am not aware of any matters that may have an adverse impact on the FMA's view
of my character during the period of my authorisation.
TRUE
I have never been dismissed or asked to resign from any position of employment or
from a position of trust, fiduciary appointment or similar position during the period
of my authorisation.
TRUE
I have never been investigated, charged, disciplined, censured, suspended or
criticised by a regulatory or professional body, court or tribunal during the period
of my authorisation.
TRUE
FALSE
FALSE
Details:
5b
FALSE
Details:
5c
Details:
Application for Renewal of AFA Authorisation | Page 2
Please select TRUE or FALSE for each statement. If you select FALSE for any statement, you must provide
full details of the circumstances in the space provided.
I have never been the subject of any disciplinary or criminal charges or dispute
TRUE
5d
resolution matters or civil proceedings, including current or pending matters,
FALSE
during the period of my authorisation.
Details:
I have never been, during the period of my authorisation:
5e
•
•
•
•
a director of; or
a partner in; or
held any form of controlling equity ownership in; or
held a position of senior management in:
TRUE
any business which has gone into liquidation or receivership while I was connected
to that organisation or within one year of that connection.
FALSE
I have never been found to display a lack of willingness to comply with legal
obligations, regulatory requirements or professional standards during the period of
my authorisation.
TRUE
FALSE
I have never been obstructive, misleading or untruthful in dealings with others
during the period of my authorisation.
TRUE
I have never breached fiduciary obligations or other obligations involving trust
during the period of my authorisation.
TRUE
I have never failed to deal appropriately with conflicts of interest during the period
of my authorisation.
TRUE
I have never been involved in negligent, deceitful or otherwise discreditable
business or professional practices during the period of my authorisation.
TRUE
I have never failed to manage business or personal debts or financial affairs
satisfactorily during the period of my authorisation.
TRUE
Details:
5f
Details:
5g
FALSE
Details:
5h
FALSE
Details:
5i
FALSE
Details:
5j
FALSE
Details:
5k
FALSE
Details:
Application for Renewal of AFA Authorisation | Page 3
Dispute Resolution Scheme (DRS)
6
not been the subject of a complaint lodged against
DRS during the period of
authorisation.
to
DRS or any of
TRUE
Details:
The Financial Advisers Act 2008
7
complied with all
obligations under the Financial
during the period of
authorisation.
TRUE
Details:
Terms and Conditions of Authorisation
8
complied with the
period of
authorisation.
and conditions of
authorisation during the
TRUE
Details:
Minimum Professional standards for AFA in the Code
9
complied with the minimum professional standards for AFAs in the Code of
Professional Conduct for Authorised Financial
(Code) during the period of
authorisation.
TRUE
Details:
10
complied with the requirements of Code Standard (professional
development plan) and Code Standard (continuing professional training) during
period of
authorisation.
Please Note: The FMA
you to provide
records
your
Code Standard and Code Standard
TRUE
evidence of
Details:
Application for Renewal of AFA Authorisation | Page 4
Add Financial Adviser Service (FAS) scope
I apply to vary my Authorisation to add a Financial Adviser Service (FAS) to my
current FAS scope.
YES
NO
I have selected from the dropdown box below the FAS scope I wish to be authorised for.
Competence
Please read the FAS scope table on page 13 of the AFA Authorisation Guide to determine the
competence requirements that you will require for the FAS scope you have selected.
The table sets out the Unit Standard Sets you need to meet the competence requirements for
authorisation in each FAS scope. To assist you to understand the competence requirements please
read Code Standards 14 - 16 and Schedule G of the Code.
If you have already passed the Unit Standard Sets required for the FAS scope you have selected
when you were first authorised, then you will not have to provide any further evidence that you
meet the competence requirements for the FAS scope you have selected.
If you have not passed all of the Unit Standard Sets required for the FAS scope you have selected,
you will need to provide evidence to the FMA that you have passed the outstanding Unit Standard
Sets required.
The Code lists the qualifications and designations which are acceptable alternatives to certain Unit
Standard sets which are listed in Schedule G of the Code and defined in Schedule H. If you wish to
rely on any of these alternative qualifications or designations you will need to attach them to this
form when submitting your application. Section G of the Code describes what evidence of the
qualifications is required to be submitted to the FMA.
Documents to attach
If you
a FAS scope which requires you to
please
that shows you
passed the outstanding Unit Standard Sets and/
attach copies of the
of any alternative qualifications and designations that
required when you submit
list the attached documents below.
your application form.
Details:
Remove FAS scope
If you wish to remove a FAS scope from your authorisation please email the FMA at
[email protected]
Application for Renewal of AFA Authorisation | Page 5
Fee details
Application fee payment
The renewal application fee is $572.44 including GST which is payable to the FMA.You can pay
your fee via internet banking or in person at a Westpac branch.
How to pay your fee:
Internet Banking
This is a guide for paying your renewal application fee by internet banking. If you need help, please
contact your bank.
• Log into your personal internet banking website and select the option to set up a bill
payment.
• Select the option to 'add a new bill payment', add a new payee and select Financial Markets
Authority from the list of payees.
• To ensure your payment is allocated correctly, you must enter:
Particulars= FSP Number
• Enter the full amount of the fee.
Code= Name
Reference= AFA Renewal
Note: Some mobile internet banking applications do not allow you to edit the reference field.
If you make an error or entered wrong reference details please
email [email protected] to ensure your payment is correctly allocated.
In person at a Westpac Branch:
You can pay by cash or cheque at Westpac branches with Smart ATMs:
• Follow the step by step instructions and keep your receipt.
• FMA's bank account number: 03-0584-0198005-003
• To ensure your payment is allocated correctly, you must enter:
Particulars= FSP Number
Code= Name
Reference= AFA Renewal
• Please note that credit card payment is not yet available.
Confirmation
I confirm that I have paid the renewal application fee of $572.44 to the FMA's bank
account on
Select date
dd/mm/yyyy
Application for Renewal of AFA Authorisation | Page 6
Confirmation and Declaration
Confirmation
In submitting this application to the FMA I authorise the FMA to collect personal information from
any person, including any New Zealand or overseas government agency or education provider (a
Third Party) for the purpose of determining my eligibility to be authorised, including carrying out
identity, good character, qualification, and criminal checks.
For that purpose I authorise the FMA to disclose personal information to the Third Party, and the
Third Party to disclose personal information to the FMA.
Signature:
Dated
Declaration
I
full name
of
Town/city
declare that all the information provided by me in this application to the FMA is true and correct to
the best of my knowledge.
I acknowledge that knowingly making a false or misleading representation or omission or submitting
a document that is not genuine, is a criminal offence under section 136 of the Financial Advisers Act
punishable by a fine not exceeding $100,000.
Declared:
Signature required
Dated:
Application for Renewal of AFA Authorisation | Page 7